No 3M action required. This modifier is used to signal to MCOs that they must pay the billing provider the applicable FFS APG reimbursment amount for the E&M code. This modifier is used for Managed Care ONLY.

HQ

Group Setting

DOH

07/01/11

451

50% reduction in payment.

JW

Drug amount discarded/not administered to any patient

All Agencies

01/01/15

01/01/15

All paying drug APGs (pricer does not check for APG)

For payable APG drug bands- Added to second line and no payment for line with modifier. For drugs on APG fee schedule- Added to the second line and payment for line with modifier made based on units provided.

KP

First drug of a multiple drug unit use formulation

OASAS

10/01/12

10/01/12

322

Doubles payment for first H0020 on a claim.

PA

Surgical procedure on wrong body part

DOH

07/01/12

07/01/12

All

No payment for line with modifier.

PB

Surgical procedure on wrong patient

DOH

07/01/12

07/01/12

All

No payment for line with modifier.

PC

Wrong surgery or procedure on patient

DOH

07/01/12

07/01/12

All

No payment for line with modifier.

SA

Nurse Practitioner

OMH, OASAS

10/01/10

315, 316, 317, 318, 323

20% increase for 318; 45% increase for all others.

SL

State Supplied Vaccine (VFC program)

DOH

12/01/08

10/01/11

414, 415, 416

Pays $17.85 for line based on proxy weight and statewide base rate. Retro to Dec 2008. Don't code admin/inj code.

U4

Language Other Than English

OMH

07/01/10

310, 312, 315–318, 321, 323, 426, 490 (10/01/10)

10% increase in payment.

U5

Reduced Services

OMH

01/01/11

315, 316, 317, 318, 323

30% reduction in payment - SBHC for OMH.

U6

Reimbursable Ancillary

DOH

07/01/11

All ancillary APGs as defined by NYS

Allows payment for ancillary APGs.

UC

Observation provided in a Distinct Unit

DOH

04/01/13

450

Pays 100% of the allowed weight when appended to Px code G0378. If modifier is not present, 80% is paid.